Skin Conditions Flashcards
Acne (Acne vulgaris)
Blockage of follicles and sebaceous glands, causing buildup of sebum, natural oil and dead cells.
Open comedones (blackheads)
Closed comedones (white heads)
Papules (small red bumps)
Pustules (white or yellow squeezable spots)
Erythematous macules (red marks from healed spots)
Management
Mild (<20 comedones)
- Topical antiseptic wash
Moderate (20-100 comedones)
- Antibiotics (tetracycline)
Severe (>100 comedones)
- Isotretinoin (which reduces sebum production and shrinks sebaceous gland)
Bowen’s Disease (Squamous Cell Carcinoma in situ)
Sun spot that is irregular. Squamous cells have become disordered and become scaly
Management
- Photodynamic therapy
- Cryotherapy
- Local chemotherapy (5-fluorouracil)
- Excision
Basal Cell Carcinoma
A lesion of pearly appearance with rolled edges and telangectasia. Often bleeds spontaneously then seems to heal over
Risk Factors
Fair skin
Sunlight exposure
Age (>40 years)
Previous BCC
Arsenic
Basal cell neavus syndrome
Management
- Excision
- Cryotherapy
- imiquimod cream.
Calluses and Corns
Localised thickened skin at pressure points. Corns are inflamed and painful
Site: Pressure points
Management
Relieve pressure on the affected area of skin
Reduce skin thickness (sandpaper the heel)
Ease discomfort of painful cracks (fissures) with creams
Dermatitis/ Eczema
- Acute dermatitis* refers to rapidly evolving red rash which may be blistered and swollen
- Chronic dermatitis* refers to a longstanding irritable area
Types
Nummular dermatitis (discoid eczema)
Seborrhoeic dermatitis
Atopic dermatitis
Allergic contact dermatitis
Irritant contact dermatitis
Dry skin
Management
Bathing
Clothing
Moisturise / Emollients
Reduce irritants
Topical steroids
Antibiotics
Erythema Multiforme
Few to hundreds of skin lesions erupt with a 24-hour period.
Site: first on the backs of hands/tops of feet, then spread along the limbs towards the trunk
Hypersensitivity reaction triggered by infections, most commonly herpes simplex virus (HSV). Infections are probably associated with at least 90% of cases of EM.
Management
The rash settles with no treatment over several weeks without complicationsHowever, antihistamines +/- topical steroids can be used and treatment directed at a cause (aciclovir)
Hemangioma
Can be superficial (strawberry), deep or mixed lesions
Site: head and neck areas (80%)
Proliferating endothelial cells of the blood vessel lineage
80% max size in three months, stop in 5 months. Regression can take 3-10 years
Management
Propranolol or topical beta blockers for superficial cases
Herpes stomatitis (Herpes simplex)
Vesicles (little blisters) occur in white patches on the tongue, throat, palate and insides of the cheek. The white patches are followed by ulcers with a yellowish coating. Associated with fever, pharyngitis & dribbling
Site:
Initially: tongue, throat, palate and insides of the cheeks.
Recurrent: Face and lips
Aetiology
Herpes simplex virus:
Type 1: mainly facial infections (cold sore or fever blisters)
Type 2: mainly genital herpes
Initial infection usually occurs at age 1-5 years and recurrences can be triggered by trauma, URTIs, UV, stress, surgery
Management
Mild eruptions require no treatment. More severe sepsis requires aciclovir
Antiviral drugs stop HSV multiplying once it reaches the skin but cannot eradicate it from its resting stage with the nerve cells
Imetigo
Presents with pustules and round oozing patches which grow larger day by day.There may be clear blisters (bullous impetigo) or golden yellow crusts.
Site: exposed areas such as the hands and face, or in skin folds, or in particular skin folds in the armpit
Aetiology
Strep pyogenes and/or Staph aureus are responsible for impetigo
contagious with entry at graze, insect bite or scratched eczema
Management
Soak moist or crusted areas Antiseptic or antibiotic ointment Oral antibiotics (flucloxacillin) General measures such as cover the affected site, avoid contact with others
Lice
Lice usually cause an itch and irritation in the scalp. This can cause crusting and scaling on the skin.
Occasional secondary bacterial infection may result in small sores.It is easier to detect by wet combing using a lice comb
Aetiology
Lice (singular is louse) are insects that live on rather than in the body.
Pediculus capitis - head lice
Pediculus humanus - body lice
Phthirus pubis - pubic lice (crabs)
Management
Insecticides:
- Maldison
- Permethrin
- Pyrethrins
Lichen planus
Classical lichen plans is characterised by shiny, flat-topped, firm papules (bumps) varying from point size to larger than a cm.They are purple in colour and often crossed by fine white lines (Whickham striae)
Site: any, usually front of wrists, lower back and ankles
Aetiology
Abnormal immune reaction provoked by viral reaction or a drug
Management
A biopsy is needed to confirm the diagnosis
85% clear within 18 months
Mouth or genitals persist longer
If needed, topical or oral steroids can be used
Melanoma
Types
-Superficial Spreading (70%)
-Lentigo MM (5%)
-Nodular (15%)
-Acral lentiginous (10%)
-Desmoplastic
ABCDE
-Asymmetry
-Border
-Colour variegation (can be non-pigmented)
-Diameter >6mm
-Enlargement over months
Aetiology
1/3 from melanocytic naevi (5% of melanocytic naevi) A malignant growth of epithelial cells. It often metastasises
Management
Wide local excision
Measles
Initially common cold-like symptoms (fever, conjunctivitis, cough, Koplik spots in the mouth).Between 3-7 days later a red blotchy rash appears on the face then becomes more generalised (picture)
Aetiology
A highly contagious disease caused by measles virus. Incubation ranges from 7-14 days. The rash begins to fade 3-4 days after it appears but the cough may take 1-3 weeks
Management
Paracetamol for feverMaintain fluid intake30% have complications such as diarrhoea, otitis media, pneumonia
Molluscum contagiosum
There are clusters of small bumps (papules). They often have waxy, pinkish look with a small central pit (umbilicated)
Site: In warm moist places like the armpit, groin or behind the knees
Aetiology
harmless virus that may persist for months or occasionally a couple of years. Rarely it can leave tiny pit-like scars
Management
Usually no specific therapy
Treatments include:
- minor surgery
- cryotherapy
- wart paints (salicylic acid)
Naevi
Types
- Congenital
- Haemangiomas (most common)
- Acquired (moles)
- Mongolian spots
Coloured skin markings. Congenital naevi present as single or multi-shaded pigmented patches. Often oval shaped and uniform
Site: anywhere
Aetiology
Are from visible clusters of certain cell types on the skin. Eg melanocytic naevi are clusters of pigmented cells
Management
No treatment required other than cosmetic
Peri-oral Dermatitis
Groups of itchy or tender small red papules appear most often around the mouth and may spread to the upper lip and cheeks. Rarely it may affect the skin around the eyes (periocular)
Common in adult women, rare in women and occasionally will affect children
Aetiology
Unknown. Washing the face with soap instead of water, using face creams or topical steroids (most frequently)
Management
Discontinue all facial creamsConsider a course of antibiotics
Pityriasis rosea
A single scaling patch (the herald patch) appears 1-20 days before the general rash. It is oval and pink with a scale trailing just inside the edge of the lesion. In most cases it isn’t very itchy
Aetiology
Unknown. May be set off by a viral infection but doesn’t seem to be contagious
Management
Cease soap (as this irritates it) Apply moisturiser to dry skin
Use steroid cream if itchyIt usually lasts 6-12 weeks
Psoriasis
Red, scaly patches of skin with very well defined edges. Often symmetrical, with a silvery white scale.Site: can be a few dry patches on the backs of elbows and knees. It can affect any area of skin
Aetiology
Unknown
Genetic link
Immune defects
Stress
Skin injury
Medications
- Lithium
- Antimalarials
- Quinidine
- Indomethacin
Management
Mild
- emolients or weak topical corticosteroid
Disabling or disfiguring
- phototherapy
- systemic drugs (antimetabolites, immunosuppresants, biological agents)
Ring worm(Tinea corposis)
Advancing round or oval red scaly patches, often less red and scaly or even healed in the middle. Acute tinea presents with itchy, inflamed red patches and may be pustular.
Chronic tinea is common in skin folds
Site: Trunk, legs, arms
Aetiology
A dermatophyte fungus, such as Tichophyton rubrum
Management
- Topical antifungals, terbinafine cream- Oral therapy (fluconazole)
Rosacea
A chronic rash with red papules and occasionally dome shaped pustules. Characteristic of frequent flushing or blushing, a red face due to prominent blood vessels
Site: central face
Aetiology
Unknown
Genetic
Vascular
Inflammatory factors
Chronic UV exposure plays a part
Management
Topical antibiotics, metronidazole cream or clindamycin cream.
Doxycycline or laser therapy can be used
Rubella(German measles)
25-50% of cases are so mild there may be few or no signs of symptoms.
Symptoms include slight fever, sore throat, runny nose and malaise.
Rash begins on the face, spreads to the neck, trunk and extremities. Tender or swollen glands may occur
Site: Face, neck, trunk and extremities
Aetiology
Viral disease
Management
A self-limiting infection, that is of little consequence, unless you are pregnant
Congenital rubella syndrome commonly results in miscarriage, still birth or hearing loss, meningoencephalitis
Scabies
Pruritic, generalised rash, nodules, and acropustulosis (blisters and pustules) in infants
Aetiology
A mite, Sarcoptes scabei var hominis. Acquired by skin-to-skin contact (holding hands), not due to poor hygiene
Management
Chemical insecticides such as permethrin or benzyl benzoate
Seborrheic keratoses
Circumscribed wartlike lesions that can be pruritic and covered with a greasy crust.
Site: on covered and uncovered areas of the ski
Aetiology
Circumscribed wartlike lesions that can be pruritic and covered with a greasy crust. Site: on covered and uncovered areas of the skin
Management
Easily removed by:
- cryotherapy
- curettage and cautery
- laser surgery
- shave biopsy
Seborrheic dermatitis/eczema
Ill-defined dry pink skin or skin coloured patches with yellowish or white bran-like scale
Site: eyebrows, on edges of eyelids (blepharitis), inside and behind ears in the creases beside the nose
Aetiology
An inflammatory reaction to normal skin flora, yeast Malassezia. It produces a toxic substance that irritates the skin.Aggravated by illness, stress, fatigue, reduced health and change of season
Management
Regular use of anti fungal agents:
- topical ketoconazole
Intermittent topical steroids:
- hydrocortisone cream
Skin tag
Skin coloured or darker peculated lesions ranging in size from 1mm - 5cm
Site: skin folds (neck, armpits, groin)
Aetiology
Unknown
Chaffing and irritation from skin rubbing together, growth factors, insulin resistance and HPV
Management
Removal by:
- cryotherapy
- excision
- electrosurgery
- ligation
Solar keratosis(Actinic keratosis)
Appear as multiple flat or thickened, scaly or warty, skin coloured or reddened lesions. A keratosis may develop into a cutaneous horn
Site: sun exposed areas such as the backs of the hands and the face (especially the nose, cheeks, upper lip, temples, and forehead)
Aetiology
Exposure to UV radiation
Very common in fair skinned individuals or those working long-periods outdoors
Can develop to BCC or malignant melanoma
Management
Removal by:
- cryotherapy
- excision
- electrosurgery
- ligation
Solar lentigines
Commonly known as age spots or liver spots.
Benign sun-induced lesion
Site: sun-exposed areas - face, arms, hands
Aetiology
Exposure to UV light and age
Management
On removed for cosmetic reasons
Squamous Cell Carcinoma
SCCs are slowly growing, tender, scaly or crusted papules. The lesions may develop sores or ulcers that fail to heal
Greater than 2cm in diameter and 2mm depth increase risk of spread
Aetiology
Squamous cell malignancy
They are keratinising i.e. they produce keratin, the horny protein that makes up skin, hair and nails
Management
Excision or radiotherapy
Syphilis
A chancre is the hallmark of primary syphilis. It is a firm red painless papule that quickly ulcerates
Aetiology
Bacteria Treponema pallidum, an STI
Management
Heals within 4-8 weeks with or without treatment
Treat with penicillin
Urticaria
Generalised ordinary urticaria presents with spontaneous weals (swelling of the surface skin). They can be white or red, often surrounded by an itchy red flare.
The surface weals may be accompanied by deeper swelling of the eyelids, lips, hands and elsewhere (angiodema)
Site: anywhere
Aetiology
Autoimmune. Histamine release from mast cells cause blood vessels to leak. Due to preceding viral infection, drug allergies and IgE-mediated food reactions
Rarely, due to SLE, schnitzler syndrome
Management
Oral antihistamines
- non sedating during the day
— loratadine (CLARATYNE)
— desloratadine
- sedating for the night
— chlorpheniramine
— promethazine
Varicella zoster
Chickenpox usually begins as an pruritic rash or red papules (small bumps) progressing to vesicles (blisters)
Site: on the stomach, back and face, then spreading to other parts of the body
Plus they may also have high fever, headache, cold like symptoms
Aetiology
Varicella-zoster virus (herpes zoster) “chickenpox”
Management
Lesions clear 1-3 weeks but can leave a scar
Treatment:
- trim childs fingernails
- paracetamol
- calamine lotion (for pruritus)
- aciclovir for at risk
Warts
Warts have a hard warty or verrucous surface. Commonly with small black dot in the middle of the scaly spot due to thromboses capillary blood vessel
Site: (common warts) backs of fingers or toes, and on the knees
Aetiology
HPV infection
Management
In children, even without treatment, 50% of warts disappear within 6 months: 90% are join in 2 years. They are more persistent in adultsTreatment:- Salicylic acid- Cyrotherapy- Electrosurgery
